A wide range of skin reactions has occurred following the coronavirus vaccination. Some people have had symptoms that are similar to COVID-19, but none of these was severe. Data from an international registry shows this.
In 414 people who took the Moderna and Pfizer vaccines, many rashes, eruptions, and injection-site inflammation were reported. Also, some people had episodes of zoster (shingles) or rosacea-like reactions. A few people developed pernio/chilblains, better known as “COVID toes.” Most of these reactions were mild and went away on their own. No severe reactions were seen in these tests.
The COVID-19 Dermatology Registry is a joint effort by the American Academy of Dermatology and the International League of Dermatologic Societies. It was discussed at their most recent virtual meeting and published simultaneously in the Journal of the American Academy of Dermatology.
“We have seen skin reactions in people who use the COVID-19 vaccine, but this paper is different because it looks at many types of reactions that were not reported by clinical trials,” said Dr Esther Freeman. “The clinical trials looked at their major endpoints and didn’t provide a lot of detail on the kind of skin reactions seen in patients.”
COVID-19 is a virus that can cause specific skin reactions. In March of 2020, the registry was created to collect information from people who had these symptoms. In December, they started collecting information about vaccine-related skin reactions. They recorded how many doses of the vaccine people got and what happened after they were given the shot.
The report was at first only on the skin reactions from two vaccines with a European Union Authorisation. Of the 414 reactions documented, 83% occurred in patients vaccinated with the Moderna vaccine and 17% in patients who received the Pfizer vaccine.
There is information about both vaccines. After the first dose, 29 people had a skin reaction. And after the second dose, there were 31 people. The Moderna vaccine caused most of these reactions (66% after the first and 30% after the second).
“People were asking for medical treatment because they thought that the delayed reactions had something to do with cellulitis or skin infection,” said Freeman. “We were able to reassure them.”
Reactions that happen right after you get a vaccine or in a few hours afterwards could be rare allergic reactions. These require prompt medical attention and are different from the common responses that happen at the injection site. The most common manifestations of localized injection-site reactions were swelling, erythema, and pain. 54% had swelling after their first dose, and 70% had it after their second dose. 49% had erythema (redness), and 67% had it with their second dose. 35% of people experienced pain when they got their first dose, but 59% experienced it with their second one
Urticaria is a type of rash that can happen to people after they have the Moderna vaccine. In most cases, the inflammation occurs more than 24 hours later. Sometimes, it might happen within 24 hours after the person gets vaccinated. It appeared in 4% of patients who got the Moderna vaccine for the first time and 6% for those who got it their second time.
Erythromelalgia is another type of rash that can happen to people when they get the Moderna vaccine. This happened to 5% of people who received their second dose and 4% of patients who received their first dose. Cosmetic filler reactions also can occur with some vaccines, happening in 4% in those who had two doses and 9%.
The Pfizer group had a smaller sample size, but they found the same pattern of skin reactions as Moderna. Delayed significant local reactions happened after 15% of first doses and after 18% of second doses. Local injection-site reactions occurred after 24% and 25% of first and second doses, respectively. The most common manifestations of these types were swelling (18% and 15%), erythema (18% and 20%), or pain (24% and 18%).
After vaccination with the Pfizer vaccine, people got hives more often (26% and 18%) and a rash that looked like measles (18% and 7.5%). These things happened after the first dose in both cases. People also got these exact symptoms after the second dose of the Pfizer vaccine. Around eight people had pernio/chilblains after both doses of both vaccines, which is when your skin swells up from being too cold for too long.
“I think this is interesting because it shows that our body is mounting an immune response to the vaccine, just like it does after infection with the virus,” said Freeman. The registry added to a recent report of zoster flare as a skin reaction associated with COVID vaccination. This includes ten bursts, five after the first dose of Moderna vaccine, one after an initial Pfizer vaccine and four after the second Pfizer dose. Not uncommonly, skin reactions were accompanied by systemic effects, including fatigue, myalgia (muscle pain), headache (pain in your head), fever (when you have a high temperature), arthralgia (joint pain), nausea (feeling sick).